Effects of home-based intervention on unplanned readmissions and out-of-hospital deaths.
OBJECTIVE
To determine the effect of a home-based intervention (HBI) on the frequency of unplanned readmission and out-of-hospital death among patients discharged home from acute hospital care.


METHODS
A randomized controlled trial comparing HBI with usual care (UC).


METHODS
A tertiary referral hospital servicing the northwestern region of Adelaide, South Australia.


METHODS
Medical and surgical patients (n = 762) discharged home after hospitalization.


METHODS
Home-based intervention (n = 381) consisted of counseling of all patients before discharge followed by a single home visit (by a nurse and pharmacist) to those patients considered to be at high risk of readmission (n = 314) in order to optimize compliance with and knowledge of the treatment regimen, identify early clinical deterioration, and intensify follow-up of such patients where appropriate.


METHODS
The primary endpoint was the number of unplanned readmissions plus out-of-hospital deaths over a 6-month follow-up period.


RESULTS
During the study follow-up, the major endpoint occurred most commonly in the UC group (217 vs 155 episodes: P < .001). Overall, the HBI group demonstrated fewer unplanned readmissions (154 vs 197: P = .022), out-of-hospital deaths (1 vs. 20: P < .001), total deaths (12 vs. 29: P = .006), emergency department attendances (236 vs 314: P < .001), and total days of hospitalization (1452 vs 1766: P < .001). There was a disproportionate reduction in multiple events among HBI patients (P = .035). Hospital-based costs of health care during study follow-up tended to be lower in the HBI group ($A2190 vs $A2680 per patient: P = .102). Mean cost of HBI was $A190 per patient visited, whereas other community-based health care costs were similar for both groups.


CONCLUSIONS
Among high-risk patients discharged from acute hospital care, HBI is beneficial in limiting unplanned readmissions and reducing risk of out-of-hospital death. It may be particularly cost-effective if applied selectively to patients with a history of frequent unplanned hospital admission.
Stewart
S
S
Department of Cardiology, The Queen Elizabeth Hospital/University of Adelaide, Woodville, South Australia.
Pearson
S
S
Luke
C G
CG
Horowitz
J D
JD
D000368:Aged; D000704:Analysis of Variance; D005260:Female; D018575:Home Care Services, Hospital-Based; D006801:Humans; D008297:Male; D009026:Mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D013021:South Australia